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Updated: May 27, 2025
The diphtheritic process may spread from the pharynx to the nasal cavities, causing blocking of the nares, with a profuse ichorous discharge from the nostrils, and sometimes severe epistaxis. The infection may spread along the nasal duct to the conjunctiva. The lymph glands behind the angle of the jaw enlarge and become tender, and may suppurate from superadded infection.
His procedure is as follows: After raising a flap of conjunctiva from the neighborhood of the limbus a medium sized needle, curved and flattened towards its point and firmly grasped in a needle holder, is thrust superficially into the sclera tangentially to the upper edge of the cornea, so as to become fixed in the capsule of the eyeball.
I have as yet seen no cases of remote infection, but the report of Axenfeld and some others would indicate that this occurred following the Lagrange as well as the trephining operation, the then bulging conjunctiva having become eroded and infection having taken place through the eroded conjunctiva as shown when stained with flourescin.
Some found globules everywhere, some fibres. Students disputed whether the conjunctiva extended over the cornea or not, and worried themselves over Gaultier de Claubry's stratified layers of the skin, or Breschet's blennogenous and chromatogenous organs. The dartos was a puzzle, the central spinal canal a myth, the decidua clothed in fable as much as the golden fleece.
Bourgeois considers as predisposing moments the smoke of the camp-fires, the want of sleep, the marching during the night, and describes the affection as follows: The conjunctiva became dark red, swelled together with the eyelids; there was a greatly exaggerated lachrymal secretion associated with severe pain; the eyes were constantly wet, the photophobia reached such a degree that the men became totally blind, suffered most excruciating pain and fell on the road.
The conjunctiva hid the organ from view, but when it was pulled aside the eyeball was exposed, and in its remote position still possessed the power of vision. In some cases in which exophthalmos has been seemingly spontaneous, extreme laxity of the lids may serve as an explanation.
Jessop mentions the case of a child of eight who suffered a blow on the eye from a fall against a bedpost, followed by compound rupture of the organ. The wound in the sclerotic was three or four lines in length, and the rent in the conjunctiva was so large that it required three sutures. The chief interest in this case was the rapid and complete recovery of vision.
Recent reports speak of a child born in Portland, Oregon, which had a median rudimentary eye between two normal eyes. Fournier describes an infant born with perfectly formed eyes, but with adherent eyelids and closed ocular aperture. Forlenze has seen the pupils adherent to the conjunctiva, and by dissection has given sight to the subject. Dubois cites an instance of supernumerary eyelid.
The plica semilunaris, haw or nictitating membrane, though not as largely developed in the dog as in some other animals, is, nevertheless, of sufficient size to afford considerable protection to the ball of the eye, and assists materially in preventing the accumulation of seeds and other minute particles within the conjunctiva.
Lagrange does not recommend his operation for acute glaucoma. It is especially adapted for cases of chronic simple glaucoma." As stated in this paper I have modified the procedure to the extent of removing all the conjunctiva attached to the borders of the operative wound.
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